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By Daker Monroe

You might have heard the terms care navigation, advocacy, concierge and care management. They all pertain to helping individuals understand their benefits and properly use healthcare services. Though this isn’t a new concept, it continues to gain traction in the employee benefits ecosystem.

This segment of the benefits industry was created to solve some of its most pressing challenges, such as health literacy, fragmented care, gaps in care and point solution fatigue. An individual is often assigned a single point of contact or a care team to help the person better consume healthcare and maximize their benefits.

While healthcare is a difficult subject, some companies shy away from help. They cite a lack of member engagement, an inability to demonstrate return on investment, and duplicate services offered by medical carriers and pharmacy benefit managers.

Wherever the assistance comes from, these four key factors can help you evaluate the service to help your employees get the most out of it.

Member Engagement

Effective engagement is often the most important aspect of any program, but it is not always implemented or, if it is, it is too transactional to be beneficial. Evaluate the following three pieces of this puzzle to ensure employee engagement.

• Customization: Can the program be customized to the employer’s population and demographics? Make sure it resonates with your population.
• Definition: How does the program define engagement? Does it focus on transactions or outcomes?
• Measurement: How will the program’s success be measured? Will they monitor who did and did not engage? How will this information be used?

Finally, the employer’s benefit manager must consistently promote the program to create a culture of engagement.

Return on Investment

Evaluate how much of a savings the program provides versus its cost. The savings could come in actual dollars saved or in improved member experience.

Understand the cost and member-level interventions that the program reports and takes credit for. While indirect savings might be subjective, it can have a much greater impact on the overall consumption of healthcare and improved knowledge than direct savings.

Quantum Health released a study that found higher productivity when analyzing navigation’s impact on reducing absenteeism, presenteeism and HR burden. These gains amounted to total annual savings of nearly $424,000 for the organization.

Integration

For the concierge team to ensure proactive member engagement and effective care coordination, they will need proper technology and data. There are many claims of data integration in the marketplace, but this is often far from reality. Systems and technology within an organization can be fragmented or siloed, which may not effectively empower the care team with the data, available benefits offered or clinical knowledge that they need to help an employer’s population.

When the data is effectively integrated, it will connect the different areas of healthcare, leading to meaningful information with actionable insights that can be implemented and shared to help optimize a benefits program.

Flexibility

A care coordinator or care team coordinates the resources to support individuals across the continuum of their needs.

Each program must be flexible enough for care coordinators to understand underlying individual situations such as food insecurity, housing instability and transportation barriers. Screening for these social determinants of health can be used to link individuals with the community services needed to keep them healthy and productive.

Ultimately, a care team can address factors such as behavior, education and prevention that directly impact plan performance.

Oswald can help

Oswald will help your organization evaluate the various solutions in the marketplace to determine those that will best fit your needs. Our advisors can work with vendors to tailor a program that’s right for you and your employees.

To learn more, please contact us below or learn more on our Employee Benefits page.